Workforce Issues in the Greater Boston Health Care Industry: Implications for Work and Family

Interviews with more than 40 leaders in the Boston area health care industry have identified a range of broadly-felt critical problems. This document synthesizes these problems and places them in the context of work and family issues implicit in the organization of health care workplaces. It concludes with questions about possible ways to address such issues. The defining circumstance for the health care industry nationally as well as regionally at present is an extraordinary reorganization, not yet fully negotiated, in the provision and financing of health care. Hoped-for controls on increased costs of medical care – specifically the widespread replacement of indemnity insurance by market-based managed care and business models of operation--have fallen far short of their promise. Pressures to limit expenditures have produced dispiriting conditions for the entire healthcare workforce, from technicians and aides to nurses and physicians. Under such strains, relations between managers and workers providing care are uneasy, ranging from determined efforts to maintain respectful cooperation to adversarial negotiation. Taken together, the interviews identify five key issues affecting a broad cross-section of occupational groups, albeit in different ways: Staffing shortages of various kinds throughout the health care workforce create problems for managers and workers and also for the quality of patient care. Long work hours and inflexible schedules place pressure on virtually every part of the healthcare workforce, including physicians. Degraded and unsupportive working conditions, often the result of workplace "deskilling" and "speed up," undercut previous modes of clinical practice. Lack of opportunities for training and advancement exacerbate workforce problems in an industry where occupational categories and terms of work are in a constant state of flux. Professional and employee voices are insufficiently heard in conditions of rapid institutional reorganization and consolidation. Interviewees describe multiple impacts of these issues--on the operation of health care workplaces, on the well being of the health care workforce, and on the quality of patient care. Also apparent in the interviews, but not clearly named and defined, is the impact of these issues on the ability of workers to attend well to the needs of their families--and the reciprocal impact of workers' family tensions on workplace performance. In other words, the same things that affect patient care also affect families, and vice versa. Some workers describe feeling both guilty about raising their own family issues when their patients' needs are at stake, and resentful about the exploitation of these feelings by administrators making workplace policy. The different institutions making up the health care system have responded to their most pressing issues with a variety of specific stratagems but few that address the complexities connecting relations between work and family. The MIT Workplace Center proposes a collaborative exploration of next steps to probe these complications and to identify possible locations within the health care system for workplace experimentation with outcomes benefiting all parties.

Work Plan

Outline of work plan - days may be renegotiated according to timetabling

Oceans Deep: Lesson G (March of The Polar Bears)

Teacher resources for Lesson G in the Discover Oceanography 'Scheme of Work' for use in schools.

Analysis of the employee’s labor agreement suspension in Colombia and some legislation references

Considering that the employment contract suspension responds to labor stability,one of the most important principles of labor law is important to study it because itsprincipal purpose is to maintain the link between de employer and the employeedespite the presence of adversity or other situations that would break up the relationshipin other fields. However, at the occurrence of any of the grounds of suspensionmay be presented some questions or voids that it will try to be answer in this paper.Consequently we shall refer first to the definition, purpose and characteristics of thesuspension. Subsequently, will be analyzed in detail every single ground of contractsuspension in Colombia. Then, will be studied the effects of the suspension andwe will refer to the resumption of work, and conclude with the comparative analysisof the figure in some Hispanic countries (Mexico, Paraguay and Spain).

Development of practical methodology and indicators for on-farm animal welfare assessment

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Multi-agent collaboration for decision support in shared zones of intelligent buildings

In domain of intelligent buildings, saving energy in buildings and increasing preferences of occupants are two important factors. These factors are the important keys for evaluating the performance of work environment. In recent years, many researchers combine these areas to create the system that can change from original to the modern work environment called intelligent work environment. Due to advance of agent technology, it has received increasing attention in the area of intelligent pervasive environments. In this paper, we review several issues in intelligent buildings, with respect to the implementation of control system for intelligent buildings via multi-agent systems. Furthermore, we present the MASBO (Multi-Agent System for Building cOntrol) that has been implemented for controlling the building facilities to reach the balancing between energy efficiency and occupant’s comfort. In addition to enhance the MASBO system, the collaboration through negotiation among agents is presented.

Poverty, migration and sex work: youth transitions in Ethiopia

Despite an emerging body of work on youth transitions, research has yet to explore the often unconventional routes to adulthood for young people marginalised through poverty. By drawing on interviews with 60 young commercial sex workers in Ethiopia, this paper explores the connections between poverty, migration and sex work and demonstrates that sex work provides a risky alternative, but often successful, path to independence for some rural-urban migrants. The paper concludes by offering recommendations for policies that seek to support young sex workers by enabling them to maintain their independence while seeking different employment.

A review of currently available in-stream water-quality models and their applicability for simulating dissolved oxygen in lowland rivers

In this paper, a review is undertaken of the major models currently in use for describing water quality in freshwater river systems. The number of existing models is large because the various studies of water quality in rivers around the world have often resulted in the construction of new 'bespoke' models designed for the particular situation of that study. However, it is worth considering models that are already available, since an existing model, suitable for the purposes of the study, will save a great deal of work and may already have been established within regulatory and legal frameworks. The models chosen here are SIMCAT, TOMCAT, QUAL2E, QUASAR, MIKE-11 and ISIS, and the potential for each model is examined in relation to the issue of simulating dissolved oxygen (DO) in lowland rivers. These models have been developed for particular purposes and this review shows that no one model can provide all of the functionality required. Furthermore, all of the models contain assumptions and limitations that need to be understood if meaningful interpretations of the model simulations are to. be made. The work is concluded with the view that it is unfair to set one model against another in terms of broad applicability, but that a model of intermediate complexity, such as QUASAR, is generally well suited to simulate DO in river systems. (C) 2003 Elsevier Science B.V. All rights reserved.

Poverty, migration and sex work: youth transitions in Ethiopia

Despite an emerging body of work on youth transitions, research has yet to explore the often unconventional routes to adulthood for young people marginalised through poverty. By drawing on interviews with 60 young commercial sex workers in Ethiopia, this paper explores the connections between poverty, migration and sex work and demonstrates that sex work provides a risky alternative, but often successful, path to independence for some rural-urban migrants. The paper concludes by offering recommendations for policies that seek to support young sex workers by enabling them to maintain their independence while seeking different employment.

Understanding the seriousness of corporate crime: Some lessons for the new 'corporate manslaughter' offence

The measurement of public attitudes towards the criminal law has become an important area of research in recent years because of the perceived desirability of ensuring that the legal system reflects broader societal values. In particular, studies into public perceptions of crime seriousness have attempted to measure the degree of concordance that exists between law and public opinion in the organization and enforcement of criminal offences. These understandings of perceived crime seriousness are particularly important in relation to high-profile issues where public confidence in the law is central to the legal agenda, such as the enforcement of work-related fatality cases. A need to respond to public concern over this issue was cited as a primary justification for the introduction of the Corporate Manslaughter and Corporate Homicide Act 2007. This article will suggest that, although literature looking at the perceived seriousness of corporate crime and, particularly, health and safety offences is limited in volume and generalist in scope, important lessons can be gleaned from existing literature, and pressing questions are raised that demand further empirical investigation.

Risk and price in the bidding process of contractors

Formal and analytical risk models prescribe how risk should be incorporated in construction bids. However, the actual process of how contractors and their clients negotiate and agree on price is complex, and not clearly articulated in the literature. Using participant observation, the entire tender process was shadowed in two leading UK construction firms. This was compared to propositions in analytical models and significant differences were found. 670 hours of work observed in both firms revealed three stages of the bidding process. Bidding activities were categorized and their extent estimated as deskwork (32%), calculations (19%), meetings (14%), documents (13%), off-days (11%), conversations (7%), correspondence (3%) and travel (1%). Risk allowances of 1-2% were priced in some bids and three tiers of risk apportionment in bids were identified. However, priced risks may sometimes be excluded from the final bidding price to enhance competitiveness. Thus, although risk apportionment affects a contractor’s pricing strategy, other complex, microeconomic factors also affect price. Instead of pricing in contingencies, risk was priced mostly through contractual rather than price mechanisms, to reflect commercial imperatives. The findings explain why some assumptions underpinning analytical models may not be sustainable in practice and why what actually happens in practice is important for those who seek to model the pricing of construction bids.

Speciation and bursts of evolution

A longstanding debate in evolutionary biology concerns whether species diverge gradually through time or by rapid punctuational bursts at the time of speciation. The theory of punctuated equilibrium states that evolutionary change is characterised by short periods of rapid evolution followed by longer periods of stasis in which no change occurs. Despite years of work seeking evidence for punctuational change in the fossil record, the theory remains contentious. Further there is little consensus as to the size of the contribution of punctuational changes to overall evolutionary divergence. Here we review recent developments which show that punctuational evolution is common and widespread in gene sequence data.

A 25-year review of sequential methodology in clinical studies

This paper explores the theoretical developments and subsequent uptake of sequential methodology in clinical studies in the 25 years since Statistics in Medicine was launched. The review examines the contributions which have been made to all four phases into which clinical trials are traditionally classified and highlights major statistical advancements, together with assessing application of the techniques. The vast majority of work has been in the setting of phase III clinical trials and so emphasis will be placed here. Finally, comments are given indicating how the subject area may develop in the future.

Work performance, productivity and indoor air

Temperature, relative humidity, and air quality all affect the sensory system via thermo receptors in the skin and the olfactory system. Air quality is mainly defined by the contaminants in the air. However, the most persistent memory of any space is often its odor. Strong, emotional, and past experiences are awakened by the olfactory sense. Odors can also influence cognitive processes that affect creative task performance, as well as personal memories and moods. Besides nitrogen and oxygen, the air contains particles and many chemicals that affect the efficiency of the oxygenation process in the blood, and ultimately the air breathed affects thinking and concentration. It is important to show clients the value of spending more capital on high-quality buildings that promote good ventilation. The process of achieving indoor-air quality is a continual one throughout the design, construction, commissioning, and facilities management processes. This paper reviews the evidence.

Coming of age: a review of embodiment and the neuroscience of semantics

Over the last decade, there has been an increasing body of work that explores whether sensory and motor information is a necessary part of semantic representation and processing. This is the embodiment hypothesis. This paper presents a theoretical review of this work that is intended to be useful for researchers in the neurosciences and neuropsychology. Beginning with a historical perspective, relevant theories are placed on a continuum from strongly embodied to completely unembodied representations. Predictions are derived and neuroscientific and neuropsychological evidence that could support different theories is reviewed; finally, criticisms of embodiment are discussed. We conclude that strongly embodied and completely disembodied theories are not supported, and that the remaining theories agree that semantic representation involves some form of Convergence Zones (Damasio, 1989) and the activation of modal content. For the future, research must carefully define the boundaries of semantic processing and tackle the representation of abstract entities.